Chest
Postgraduate Education CornerChest Imaging and Pathology for CliniciansA Patient With Hearing Loss, Mediastinal Lymphadenopathy, and Cavitatory Pulmonary Nodules
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Case Report
A 60-year-old Chinese woman presented with complaints of progressive bilateral hearing loss over 3 months duration. There was no fever, tinnitus, headache, or ear discharge. Her medical history was significant for hypertension and hyperlipidemia, which were being treated with atenolol and simvastatin, respectively. She had no history of smoking, alcohol, or drug use. She was married with three children. Her systemic review was normal.
On examination, the patient was comfortable. She had a
Discussion
Wegener granulomatosis (WG) is a systemic vasculitis syndrome characterized by necrotizing granulomatous vasculitis of the upper- and lower-respiratory tracts, glomerulonephritis, and variable degrees of vasculitis predominantly of small arteries and veins. This condition commonly manifests as a triad of sinusitis, pulmonary infiltrates, and glomerulonephritis. A limited form of the disease is defined mainly by the absence of glomerular lesions, predominant respiratory tract involvement, and a
Conclusion
Mediastinal and hilar lymphadenopathy is a potential, but rare phenomenon in WG. The presence of these conditions should prompt the clinician to instead consider another diagnosis first, but WG should be considered in the list of differential diagnoses. The role of histologic sampling and use of an antineutrophil cytoplasmic antibody test may be helpful in this context.
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
References (16)
- et al.
Pulmonary Wegener's granulomatosis. A clinical and imaging study of 77 cases
Chest
(1990) - et al.
Evaluation and management of solitary and multiple pulmonary nodules
Clin Chest Med
(1992) - et al.
Pulmonary manifestations of Wegener granulomatosis: CT findings in 57 patients and a review of the literature
Eur J Radiol
(2005) - et al.
Development and standardization of solid phase assays for the detection of anti-neutrophil cytoplasmic antibodies (ANCA). A report on the second phase of an international cooperative study on the standardization of ANCA assays
J Immunol Methods
(1996) - et al.
Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis
Kidney Int
(1998) - et al.
Rapidly progressive glomerulonephritis with D-penicillamine
Am J Med Sci
(2000) - et al.
Late recurrence of Wegener's granulomatosis presenting as solitary upper lobe pulmonary mass
Eur Respir J
(1994) - et al.
Wegener's granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years
Ann Intern Med
(1983)
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